Dignity, Independence, and Self-Determination for All. State of - - PowerPoint PPT Presentation

State of Nevada Aging and Disability Services Division

Budget Presentation

Jane Gruner Administrator March 6, 2015 www.adsd.nv.gov

Dignity, Independence, and Self-Determination for All.

Jane Gruner Administrator jgruner@adsd.nv.gov

Anita Curtis Executive Assistant adcurtis@adsd.nv.gov Julie Kotchevar Deputy Administrator Early Intervention Services and Operations jdkotchevar@adsd.nv.gov Jill Berntson Deputy Administrator Aging and Disability Services Programs jberntson@adsd.nv.gov Michele Ferrall Deputy Administrator Developmental Services mferrall@adsd.nv.gov Information Technology Fiscal Support Services Rural Regional Center Sierra Regional Center Desert Regional Center Elder Rights Sally Ramm Elder Rights Attorney sramm@adsd.nv.gov Nevada Early Intervention Services Community Based Care

Department of Health and Human Services Aging and Disability Services Division (ADSD) 2016-2017 Biennium

ORGANIZATIONAL STRUCTURE

2 Autism Treatment Assistance Program Supportive Services Disability Services Sherri Vondrak Personnel Officer 2 svondrak@adsd.nv.gov Personnel Support Services Family Preservation Program

Vision: Nevadans, regardless of age or ability, will enjoy a meaningful life led with dignity and self-determination. Mission: Ensure the provision of effective supports and services to meet the needs of individuals and families, helping them lead independent, meaningful and dignified lives. Philosophy: ADSD seeks to understand and respond to the individual and his/her needs using principles of:

– Accessibility – Accountability – Culturally and linguistically appropriate services – Ethics – Mutual respect – Timeliness – Transparency

ADSD MISSION AND VISION

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• Strategic plan completed in December 2014 to guide the integration process.
• Policy workgroup consolidated and standardized appropriate policies that applied to

all programs, while respecting the individual needs of programs and maintaining the policies that were unique to their consumers and programs.

• System implementation for Developmental Services is underway with integration of

Nevada Early Intervention Services (NEIS) and the Autism Treatment Assistance Program (ATAP) planned for a future biennium. This is the first step in ensuring a seamless transition for consumers moving through the service system.

• Fiscal, IT, and personnel staff have fully integrated services and supports for all of the

support functions for the Division. Outcome: Integrate programs and services where it makes sense and provides better supports for consumers.

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INTEGRATION UPDATE

The Aging and Disability Services Division has worked diligently over the past year and a half to create integrated systems of services through:

• Collaborating and strategic planning to achieve successful outcomes with consumers,

community partners, other agencies and advocacy groups.

• Eliminating long standing areas of non-compliance in individual programs.
• Training staff and community partners toward the ADSD value system that stresses

independence, self-determination, and dignity for all consumers.

• Piloting evidence-based services for consumers across the lifespan of services.
• Seeking alternative sources of funding to support changing needs.

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AGENCY ACCOMPLISHMENTS

We Serve People – Health Services – Human Services

CORE FUNCTIONS

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SFY 2016/2017 Total Funding Request $567,284,785 STATE FISCAL YEAR 2016 – STATE FISCAL YEAR 2017 FUNDING REQUESTS

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SFY 2016/2017 Funding Request by Program

Other Funds $64,246,686 12%

Federal Funds $211,741,795 37% General Funds $291,296,304 51%

Developmental Services 62% Early Intervention Services 12% Federal Programs & Administration 11% Home & Community Based Services 15%

MAJOR BUDGET INITIATIVE

Autism Spectrum Disorder (ASD) impacts 1 in every 68 children. Since 2002, when the Centers for Disease Control (CDC) began an intensive surveillance of children with autism, the prevalence rate has increased 78%. Nevada Department of Education data indicate that over 6,000 children in Nevada have a diagnosis of

• ASD. The Department of Health and Human Services has proposed a strategy designed to treat ASD

through programs offered by Aging and Disability Services Division (ADSD) and Division of Health Care Financing and Policy (DHCFP). NRS 427A.875 established the Autism Treatment Assistance Program (ATAP) within ADSD to serve as the primary autism program within the Department and to provide and coordinate services to persons with ASD through the age of 19. ADSD has requested budget authority to serve an additional 264 children over the biennium, increasing the caseload to 836 children by the end of fiscal year 2017. DHCFP has also requested budget authority to add Applied Behavioral Analysis (ABA) services based on projections of need and provider capacity. The expansion of services would assist in filling the gaps with early intervention, school, and community programs in order to meet federal requirements and the need for services in Nevada. Combined, the initiative is expected to provide services for 2,464 children over the biennium.

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MAJOR BUDGET INITIATIVE

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Note: The table above shows direct service costs only. In the Governor's Recommended Budget, Medicaid eligible children in the ATAP program receive ATAP services and Medicaid is billed for the services rendered. BA 3266 - ADSD - Home and Community Based Services FY16 FY17 Biennium Base 7,175,230 7,175,230 14,350,460 Caseload Growth 4,914,731 9,645,424 14,560,155 General Fund 7,773,806 10,127,432 17,901,238 Tobacco 2,500,000 2,500,000 5,000,000 Medicaid 1,816,155 4,193,222 6,009,377 ADSD Total $12,089,961 $16,820,654 $28,910,615

BA 3156 SENIOR RX AND DISABILITY RX

This budget account funds the State Pharmaceutical Assistance Program, known as Senior Rx and Disability Rx. This program helps low income seniors and persons with disabilities to obtain essential prescription medications by subsidizing the cost for medication and helping with monthly premium payments. Outcome: Uninterrupted access to essential medications will permit seniors and persons with disabilities to remain healthy and independent in their community.

E710- Replaces computer hardware and software based on the EITS five year replacement schedule. FY16: $2,287 (GF = $0) E276- Requests an increase for the program in accordance with available funds for the Fund for a Healthy Nevada and based upon projected need. FY16: $330,621 (GF = $0) FY17: 352,043 (GF = $0) E902- Transfers a Management Analyst from 3156 to 3151 to better align funding. This is a companion to E902 in 3151.

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FY 2016 FY 2017 Biennium Base 3,443,465 3,448,982 6,892,447 Adjustments (488,401) (488,001) (976,402) Maintenance 37,028 12,126 49,154 Enhancements 332,908 351,893 684,801 General Funds Tobacco 3,325,000 3,325,000 6,650,000 Total $3,325,000 $3,325,000 $6,650,000

BA 3151 FEDERAL PROGRAMS AND ADMINISTRATION

This budget account supports Division administration and the Long-Term Care Ombudsman

• Program. It also provides the required match for federal grant funds, and supplements older

volunteer, senior transportation, rural senior services programs. Outcome: Effective leadership, guidance, advocacy and support will ensure quality services that result in independence, dignity, and self-determination for all consumers served by ADSD.

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FY 2016 FY 2017 Biennium Base 20,694,358 20,875,378 41,569,736 Adjustments 1,608,077 1,071,890 2,679,967 Maintenance 442,752 532,817 975,569 Enhancements 1,065,214 824,315 1,889,529 General Funds 4,170,467 4,227,104 8,397,571 Federal/Other Funds 19,639,934 19,077,296 38,717,230 Total $23,810,401 $23,304,400 $47,114,801

BA 3151 FEDERAL PROGRAMS AND ADMINISTRATION

M200- Funds and requests approval to establish a caseload for the Long-Term Care Ombudsman Program. Staffing ratio would be established at 1:60. This decision unit includes four administrative assistants and two social service program specialists to support intake. The caseload is projected to increase by 8.09% to mirror the growth in population. FY 16: $156,237 (GF = $156,237) FY17: $368,290 (GF = $368,290) E225- Requests three information technology professionals, one information technology technician, and one administrative assistant to support agency staff and providers and reduce the reliance on contracted programmers for maintenance and support. This is a companion to E227 in 3266. FY16: $114,775 (GF = $15,534) FY17: $204,107 (GF = $47,395) E228- Funds the Taskforce on Alzheimer’s Disease established by NRS 439.5083. Support includes travel for commission members to meet 4 times per year as well as some limited staff support. FY16: $49,582 (GF = $0) FY17: $49,582 (GF =$0) E285- Requests funds to support the Governor’s Taskforce on Integrated Employment established by Executive Order. FY16: $76,076 (GF = $76,076) FY17: $76,076 (GF = $76,076) E286- Request funds to support the Governor’s Commission on Aging. Support includes travel for commission members to meet. FY16: $42,540 (GF = $42,540) FY17: $42,540 (GF = $42,540) E282- Funds an update to the expired strategic plans for Senior Services and for Persons with Disabilities. This plan also serves as the state Olmstead plan. FY16: $100,000 (GF = $100,000) E229- Requests technology specific training for information technology staff. This is online training only and does not require travel. FY16: $12,900 (GF = $1,677) FY17: $12,900 (GF = $1,677) E232- Requests additional travel for division’s administrative, information technology, and fiscal staff in order to provide better support for division offices. FY16: $11,561 (GF = $2,149) FY17: 9,581 (GF = $1,866) E241- Funds anticipated increase in rent costs and costs to relocate staff in Reno from their current location to a yet to be determined location that is more conducive to serving clients. This is a companion to E241 in 3266. FY16: $34,238 (GF = $31,258) FY17: $17,525 (GF = $15,929)

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BA 3151 FEDERAL PROGRAMS AND ADMINISTRATION

E233-Requests funding for ADSD’s share of the bandwidth expansion for state offices in Elko. FY 16: $10,225 (GF = $1,329) FY17: $9,300 (GF = $1,209) E710- Replaces computer equipment hardware and associated software based on the Enterprise Information Technology Services (EITS) recommended replacement schedule. FY16: $53,837 (GF = 25,136) FY17: $48,285 (GF = $21,834) E711- Replaces a Fleet Services van utilized by Information Technology (IT) staff in Las Vegas. FY16: $2,580 (GF = $918) FY17: $5,100 (GF = $1,784) E722- Requests a Fleet Services vehicle for the IT unit in Northern Nevada. FY16: $2,580 (GF = $918) FY17: $5,100 (GF = $1,784) E712- Replaces network hardware and software based on the Enterprise Information Technology Services (EITS) recommended replacement

• schedule. FY16: $204,871 (GF = $61,872) FY17: $95,073 (GF = $28,740)

E724- Requests new equipment and software necessary to ensure personal health information is properly protected. FY16: $151,266 (GF = $45,683) FY17: $51,206 (GF = $15,479) E902- Transfers a Management Analyst from 3156 to 3151 to more properly align funding. This is a companion unit to E902 in 3156. E903- Transfers a Social Services Chief and a Social Services Program Specialist from 3266 to 3151 to more properly align funding. This is a companion to E903 in 3266.

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BA 3266 HOME AND COMMUNITY BASED SERVICES

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FY 2016 FY 2017 Biennium Base 26,455,361 26,721,261 53,176,622 Adjustments 4,316,865 3,646,472 7,963,337 Maintenance 6,144,399 11,798,729 17,943,128 Enhancements 2,586,229 2,521,690 5,107,919 General Funds 21,006,766 23,380,589 44,387,355 Federal/Other Funds 18,496,088 21,307,563 39,803,651 Total $39,502,854 $44,688,152 $84,191,006 This budget account supports services for seniors and persons with physical disabilities. Programs included in this budget account are: Community Based Care, Elder Protective Services, Autism Treatment Assistance Program, and the Disability Services Unit. Services are provided to seniors and persons with disabilities so that they may remain independent in their home and community. Outcome: Quality services and supports will enable seniors and persons with disabilities to remain safe and independent in their homes and communities. Outcome (ATAP): Early and intensive behavioral therapy will result in meaningful behavioral changes that lead toward independence, community involvement, and decreased need for lifelong supports.

BA 3266 HOME AND COMMUNITY BASED SERVICES

M200- Requests an increase to the number of seniors and persons with disabilities that can be served within the Community Based Care unit. This unit increases the COPE caseload by 20, the Homemaker program by 78, the PAS program by 20, and the HCBW for the frail elderly by 173. FY16: $1,015,682 (GF = $744,594) FY17: $2,014,654 (GF = $768,151) M201- Request would increase the number of children served in the ATAP program by 264 over the biennium. FY16: $4,914,731 (GF = $3,098,576) FY17: $9,645,424 (GF = $5,452,202) E225- Requests an elder rights specialist for the Elder Protective Services program in Elko. FY 16: $52,540 (GF = $52,420) FY17: $60,542 (GF = $60,542) E235- Requests a health program manager for the ATAP program to manage the increased program size and complexity. FY16: $69,192 (GF = $69,192) FY17: $84,166 (GF = $84,166) M540- Requests additional support for the Independent Living program. The increase is based upon the rate of inflation for goods and services. FY16: $27,874 (GF = $27,874) FY17: $52,958 (GF = $52,958) E226- Requests a social services program specialist for the interpreter oversight and training program to support persons who are Deaf and hard

• f hearing. FY16: $64,145 (GF = $0) FY17: $75,937 (GF = $0)

E230- Requests support for the Governor’s Commission on Autism Spectrum Disorder established by Executive Order. Support includes travel for commission members to meet as well as some limited staff support. FY16: $51,864 (GF = $0) FY17: $51,864 (GF = $0) E227- This is a companion to E225 in Budget 3151 and reduces the costs associated with contract programmers. E241- Request provides for anticipated increase in rent costs and costs to relocate staff in Reno from their current location to a yet to be determined location that is more conducive to serving clients. This is a companion to E241 in 3151. FY16: $107,136 (GF = $82,011) FY17: $57,321 (GF = $41,026)

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BA 3266 HOME AND COMMUNITY BASED SERVICES

E710- Replaces computer hardware and software based on the EITS five year replacement schedule. FY16: $54,288 (GF = $35,037) FY17: $54,288 (GF = $35,037) E711- Replaces hardware and software for network support based on the EITS five year replacement schedule. FY16: $7,660 (GF = $4,943) FY17: $1,600 (GF = $1,032) E903- Transfers a social services chief from budget 3266 to budget 3151. E900- Transfers the Waiver for Independent Nevadans (WIN) program from DHCFP to ADSD. The decision unit includes the transfer of twenty-three health care coordinators and two administrative assistants. E901- Transfers two health care coordinators from DHCFP to ADSD to support expected caseload growth.

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BA 3208 EARLY INTERVENTION SERVICES

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FY 2016 FY 2017 Biennium Base 32,649,819 33,011,472 65,661,291 Adjustments (126,478) (139,364) (265,842) Maintenance 835,363 1,355,448 2,190,811 Enhancements 317,003 195,721 512,724 General Funds 29,531,557 30,249,542 59,781,099 Federal/Other Funds 4,144,150 4,173,735 8,317,885 Total $33,675,707 $34,423,277 $68,098,984 This budget account supports Nevada Early Intervention Services (NEIS). NEIS identifies infants and toddlers who are at risk for or have developmental delays or disabilities. Individualized services are provided to support the child and their family. Services include such things as specialized instruction, physical therapy, occupational therapy, speech therapy, nutrition and metabolic services, pediatric services, genetics and audiology. Outcome: Early, individualized, community-based, and family-centered services will assist children and their families in achieving their full developmental potential.

BA 3208 EARLY INTERVENTION SERVICES

M200- Requests an increase in caseload by 6% over the biennium, ending with 193 additional children that can be served. The request includes two administrative assistant positions to support intake. FY16: $680,639 (GF = $653,505) FY17: $1,277,348 (GF = $1,224,092) E717- Replaces four laminators used to develop individualized curriculum for children and their families. FY16: $9,192 (GF = $9,192) E710- Replaces computer hardware and software based on the EITS five year replacement schedule. FY16: $61,260 (GF = $61,260) FY17: $42,823 (GF = $42,823) E712- Replaces network hardware and software based on the EITS five year replacement schedule. FY16: $89,019 (GF = $89,019) FY17: $89,019 (GF = $89,019) E720- Requests new equipment required for the IT infrastructure including an AC unit for the server room in Las Vegas. FY16: $14,490 (GF = $14,490) FY17: $13,500 ($13,500) E718- Replaces audiology equipment for early hearing detection that can no longer be repaired or supported. FY16: $75,325 (GF = $75,325) E721- Requests new mobile audiology equipment that can provide hearing screenings in the home, particularly in rural areas. FY16: $27,333 (GF = $27,333) FY17: $18,222 (GF = $18,222) E719- Replaces the infant scale at the Carson NEIS office. FY16: $3,880 (GF = $3,880) E722- Requests seven new fleet services vehicles to be used by developmental specialists. E490/491- Restores 3.51 positions associated with the Maternal and Child Health Block grant. These positions include two pediatricians, a registered dietician, and a clinical program planner. FY16: $587,214 (GF = $587,214) FY17: $626,432 (GF = $626,432) E937/537- Transfers a part-time health program specialist from DPBH to ADSD. This position supports the metabolic screening program at

• NEIS. This is a companion to E937 in DPBH BA 3222. FY16: $49,388 (GF = $49,388) FY17: $50,701 (GF = $50,701)

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BA 3166 FAMILY PRESERVATION PROGRAM

This budget account funds the Family Preservation Program. The Family Preservation Program provides a monthly stipend to families of persons who have a profound intellectual disability to assist with their care. The program presently pays a monthly stipend of $374 to eligible families per NRS 435.365.

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FY 2016 FY 2017 Biennium Base 2,672,978 2,672,978 5,345,956 Adjustments 114,070 114,070 228,140 Maintenance 49,368 143,616 192,984 General Funds 1,636,416 1,730,664 3,367,080 Tobacco 1,200,000 1,200,000 2,400,000 Total $2,836,416 $2,930,664 $5,767,080 Outcome: Support provided to families enables them to meet the more complex needs of their family member and keep them in their home and community.

M200- Requests an increase in caseload based on projected need. The caseload increase would permit 41 additional families to participate in the program. FY16: $49,368 (GF = $49,368) FY17: $143,616 (GF = $143,616)

BA 3167/3279/3280 DEVELOPMENTAL SERVICES

These budget accounts support the three regional centers: Sierra Regional Center (SRC), Rural Regional Center (RRC), and Desert Regional Center (DRC) that purchase or provide services to persons with intellectual disabilities and related conditions. Many of the services are funded through the Medicaid Home and Community Based Waiver for Persons with an Intellectual

• Disability. Services purchased or provided include service coordination, family supports,

residential supports, jobs and day training, clinical services. DRC is also the home of the Intermediate Care Facility.

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RRC SRC DRC Program Total Base 29,703,767 36,293,213 203,202,104 269,199,084 Adjustments 802,297 (1,065,906) (1,172,201) (1,435,810) Maintenance 4,114,338 6,036,607 18,897,697 29,048,642 Enhancements 1,156,106 2,149,959 5,371,376 8,677,441 General Funds 19,464,874 22,427,925 113,890,899 155,783,698 Federal/Other Funds 16,311,634 21,083,724 112,408,077 149,803,435 Total $35,776,508 $43,511,649 $226,298,976 $305,587,133 Outcome: Effective person-centered supports will result in independence, self-determination, and integrated community living.

BA 3167/3279/3280 DEVELOPMENTAL SERVICES

M200 (BA 3167, 3279, 3280)- Requests to increase the caseload by up to 728 additional consumers that can be served over the biennium. The request includes funding for the purchase of services along with fifteen developmental specialists, five quality assurance specialists, and one full-time and one part-time licensed psychologist, one administrative assistant, one psychiatric nurse, and one custodial worker. FY16/17: $4,118,420 (RRC), $7,888,995 (SRC), $17,929,124 (DRC) Total: $29,936,539 (GF = $16,209,009) E250 (BA 3167, 3279, 3280)- Requests a provider rate increase of 5.7% in the second year of the biennium. FY16: $0 FY17: $7,808,622 (GF = $3,965,617) E248 (BA 3167)- Funds a University of Nevada Reno extern for RRC that was previously eliminated as a result of budgetary constraints. FY16: $40,000 (GF = $40,000) FY17: $40,000 (GF = $40,000) E710 (BA 3167, 3279, 3280)- Replaces computer hardware and software based on the EITS five year replacement schedule for RRC, SRC, and

• DRC. FY16: $432,497 (GF = $432,497) FY17: $369,464 (GF = $369,464)

E720 (BA 3279) - Replaces network data management tools to ensure the safety of protected health information for DRC. FY16: $4,900 (GF = $4,900) FY17: $10,900 (GF = $10,900) E721 (BA 3279)- Purchases a new phone system for a new office location to accommodate increased staff at DRC. This is a companion to M200 in BA 3279. FY16: $53,208 (GF = $53,208) FY17: $2,500 (GF = $2,500) E711 (BA 3280)- Replaces phone system at SRC that cannot be further expanded per EITS. FY16: $97,347 (GF = $97,347) FY17: $12,267 (GF = $12,267) E276 (BA 3280)- Requests funding for additional travel at SRC to allow staff to evaluate clients currently cared for out-of-state. This assessment is necessary in order to provide transition planning for persons returning to Nevada. FY16: $1,500 (GF = $1,500) FY17: $1,500 (GF = $1,500)

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BA 3167/3279/3280 DEVELOPMENTAL SERVICES

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E730 (BA 3280)- Funds a deep cleaning of the SRC facility needed to protect the health and safety of employees and consumers. FY16: $18,566 (GF = $18,566) FY17: $0 M425 (BA 3280)- Requests deferred maintenance to replace broken concrete walkways at SRC that pose a safety hazard. FY16: $8,000 (GF = $8,000) FY17: $0 M425 (BA 3279)- Requests deferred maintenance to xeriscape the DRC campus in order to reduce utility and maintenance costs. FY16: $57,557 (GF = $57,557) FY17: $291,274 (GF = $291,274) M426 (BA 3280)- Requests deferred maintenance to replace carpet at SRC that is 15 to 18 years old and is heavily worn. FY16: $72,500 (GF = $72,500) FY17: $0

FULL TIME EQUIVALENT POSITIONS

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Budget Base Transfers Maintenance Enhancement Total FTE

3156: Senior and Disability Rx 3

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2 3151: Federal Programs & Administration 118.51 3 6 5 132.51 3266: Home and Community Based Services 149 25 12 3 189 3208: Early Intervention Services 208.37 0.51 1.51 210.39 3167: Rural Regional Center 36.28 5 41.28 3279: Desert Regional Center 303.11 17 320.11 3280: Sierra Regional Center 67.02 2.51 69.53 Total FTE 885.29 27.51 44.02 8 964.82

Outcome: Effective and qualified employees will serve as the building blocks for providing person-centered services of the highest quality.

ADSD: Aging and Disability Services Division ASD: Autism Spectrum Disorder ATAP: Autism Treatment Assistance Program ABA: Applied Behavioral Analysis COPE: Community Service Options Program for the Elderly DPBH: Division of Public and Behavioral Health DHCFP: Division of Health Care Financing and Policy FHN: Fund for a Healthy Nevada (Tobacco Settlement) FMAP: Federal Medical Assistance Percentage HCBW: Home and Community Based Waiver ICF: Intermediate Care Facility NEIS: Nevada Early Intervention Services NRS: Nevada Revised Statutes PAS: Personal Assistance Services SPAP: State Pharmaceutical Assistance Program WIN: Waiver for Independent Nevadans

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ACRONYMS

ANY QUESTIONS?

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